Root Canal Diagnosis

Getting to the root of the problem

Root canal diagnosis is the procedure of determining whether a root canal treatment, retreatment, or endodontic surgical procedure is the best solution to treat a particular dental problem. 

Prior to treatment, proper diagnosis of the problem is critical. We use multiple tests and evaluations to reach a correct diagnosis.

First of all we will assess your symptoms—meaning what you can tell us about your dental problem. How long has the tooth been bothering you? When does it bother you? Can you still function with the tooth and to what extent? History will give us many important clues, helping us make an accurate diagnosis and develop an appropriate treatment plan.

We will next assess objective signs to confirm which tooth the pain is coming from and whether root canal treatment is the best option for the patient. Various tests will be performed on multiple teeth. Accurately identifying the presence and treatability of endodontic disease is the goal of the consultation exam. When we test teeth we are looking for differences in things such as sensitivity to pressure and temperature. We may use an electric pulp tester which produces a light tingling response when teeth are healthy but no response when they are necrotic and require root canal treatment.

Radiographs (X-rays) are a critical part of diagnosis and we will take multiple radiographic images of several teeth to obtain the necessary diagnostic information. Only radiographs can determine whether the bone around the tooth root is infected, and to what degree. Our digital Radiographs use very low doses of radiation, much lower than most medical radiographic imaging. We may also require a CBCT (Cone beam computed tomography) scan of a region. This gives three-dimensional information on multiple tissue planes which can further clarify what is happening inside the tooth structure and in the bony supporting tissues surrounding the tooth root.

Basically when a tooth has damage limited to the enamel (the outermost layer of a tooth) there is usually no pain and only a filling is required. However dental pain: teeth having increased pressure, cold or heat sensitivity, are all indicators that damage is deeper, into the dentin layer of the tooth. Such teeth may have an inflamed or even infected pulp (pulpitis) which could require a root canal if this inflammation is irreversible. 

When left untreated, the pulpitis can lead to more severe pain and eventual formation of a dental abscess when the infection spreads into the bony tissues supporting the tooth root. This results in inability to chew on the tooth and increasing pain from the tooth. This soreness can spread to adjacent teeth, the sinus, or even the entire side of the face. But don’t panic! Root canal treatment of a single tooth will almost always alleviate all your pain.

With toothaches and infected teeth you may experience swelling of the adjacent gum tissue and the formation of a purulent abscess (fluid releasing boil) on the gums adjacent to the diseased tooth; this may cause a foul taste in the mouth and even bad breath. This is usually a clear indication root canal treatment is required.

Other symptoms a patient may experience from a dental infection can include fever, swollen glands in the neck or jaw, lethargy and tiredness. These systemic symptoms may indicate a potentially serious infection which requires prompt root canal treatment and possibly a course of antibiotics.

Sometimes we are unable to come to a definitive diagnosis. Unless we are sure of the tooth causing the problem—and are sure a tooth is causing the problem—we will not begin any treatment. Instead we will recommend you come back for reassessment on another day or refer you to another specialist. There is no additional charge for a reassessment appointment that is a continuation of a consult visit.